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This article reports the results of a review of all maternal deaths occurring in Jamaica in 1981-83. A total of 192 maternal deaths were identified, yielding a maternal mortality rate of 10.8/10,000 live births, which was considerably higher than the official rate of 4.8. 15% of these deaths were associated with abortion or ectopic pregnancy. The most common causes of death were hypertensive diseases of pregnancy (26%), hemorrhage (20%), ectopic pregnancy (10%), pulmonary embolus (8%), and sepsis (8%). Maternal mortality was closely related to both age and parity. Lowest rates were noted among women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years. Avoidable factors were judged to be present in 68% of the deaths. The largest categories of avoidable factors were: nonuse of and deficiencies in antenatal care; inadequacy in ensuring the delivery in hospital of high-risk women; and delays in taking action when signs of complications developed before, during, and after delivery. In response to these findings, the Ministry of Health's Maternal Mortality Committee has called for the following actions: measures to encourage women to seek antenatal care early in pregnancy; improvements in antenatal monitoring; the referral of high-risk women for hospital delivery; the definition of standard procedures for dealing with specific complications of pregnancy, e.g., eclampsia and hemorrhage; regionalization of obstetric services and criteria for referring patients to hospital; and review of provision of blood and plasma for emergency transfusions.
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PMID:Maternal mortality in Jamaica. 286 18

In a 13-year review of maternal deaths at the University of Benin Teaching Hospital, Benin City, abortion was one of the 3 major causes of death, accounting for 37 (22.4%) out of the 165 deaths. Induced abortion was responsible for 34 (91.9%) of these deaths. The usual victim is the teenage, inexperienced school girl who has no ready access to contraceptive practice. Death was mainly due to sepsis (including tetanus), hemorrhage and trauma to vital organs, complications directly attributable to faulty techniques by unskilled abortion providers, a by-product of the present restrictive abortion laws. Total overhaul of maternal child health services and the family health education system, are suggested. Contraceptive practice should be made available to all categories of women at risk, and the cost subsidized by governmental and institutional bodies. Where unwanted pregnancies occur, the authors advocate termination in appropriate health institutions where lethal and sometimes fatal complications are unlikely to occur. In effect, from the results of this study and a review of studies on abortion deaths in Nigeria and other developing countries, it is obvious that a revision of abortion laws as they operate, notably in the African continent, is overdue.
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PMID:Abortion-related morbidity and mortality in Benin City, Nigeria: 1973-1985. 290 Jan 75

The maternal mortality rate in 10 hospitals scattered all over Anambra State, Nigeria, in a 5-year period were studied. The hospitals covered urban, semi-urban and rural areas. The maternal mortality rate varied from 1.8 to 13/1000 with a mean of 4.97/1000. This mean is 45 times the rate in England in 1978 and also compared less favorably with some other figures from third world sources. Attributable causes included obstetric hemorrhage (23%), ruptured uterus (27.6%), obstructed labor (13%), sepsis (12.1%), eclampsia (7.9%), anemia (2.9%), septic abortion (2.1%) and other causes. 16.7% of deaths were among 16-20 year olds; 14.6% among 21-25 year olds, 27.2% among 26-30 year olds; 18.8% among 31-35 year olds; and 22.6% among women older than 35. 87.5% of the women were unbooked. Of the 239 cases, 51 delivered vaginally, 162 by cesarean section, 12 by breech, 5 by TOP and 5 by destruction. Parity and age were important influences; at highest risk were primigravida and the grandmultipara, especially between para 4 and para 5. All the major causes of death are avoidable--either by obtaining prenatal and intrapartal care or by anticipating fetopelvic disproportion or abnormal lie. Lack of access to health facilities, especially in the rural areas, poor transportation, great distances to nearest health facility, are all implicated in obstructed labor deaths. Most cases of hemorrhage are avoidable through early diagnosis and recognition of high risk cases, prophylactic measures and availablity of blood transfusion and surgical delivery. Lack of antibiotics and non-adherence to normal aseptic precautions were also problems, especially in the 5 deaths from illegal abortions. Changes in the mortality rate can be made by accurate data collection, improved health facilities, improved socioeconomic status and basic education.
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PMID:Maternal mortality in Anambra State of Nigeria. 290 99

In a regional population of 32,120 liveborn newborn infants 65 (0.2%) had a birthweight less than or equal to 900 g (extremely small low birthweight = ESLBW) with mean gestational age 26.4 (range 22-31) completed weeks of gestation. The total 0-1 year survival rate was 48%. For the 42 infants treated in the Level III regional neonatal intensive care unit (NICU) the 0-1 year survival rate was 55% versus 34% for 23 infants not transferred to the Level III unit. In the ESLBW infants treated in the regional NICU the major complications were respiratory disorders requiring artificial ventilation (73%), bronchopulmonary dysplasia (26%), intracranial haemorrhages (40%), symptomatic persistent ductus arteriosus (36%) and sepsis (14%), persistent retinopathy of prematurity (8%). Duration of NICU treatment was 51 days (range 10-95) for survivors. Mode of delivery and rate of perinatal complications did not differ between survivors and non-survivors. Previous legal abortion occurred in 24%, fertility problems in 29% and 21% of the mothers were immigrants. Otherwise no significant abnormalities were found in maternal or socioeconomic conditions. Factors deciding neonatal outcome in the tiniest babies seem to be a combination of prenatal circumstances and neonatal minute fine care procedures.
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PMID:Neonatal outcome of extremely small low birthweight liveborn infants below 901 g in a Swedish population. 292 41

Depending on the extent of infection, abortions are usually classified as uncomplicated infected (feverish) abortions, in which only the fertilized egg and uterus are infected; complicated infected abortions, in which infection has spread beyond the uterus but remains localized in the pelvis minor; and septic abortions, in which infection has spread beyond the pelvis minor and become generalized. Disagreements are possible when defining uncomplicated and complicated abortions, since the term "infection within the uterus" can signify several inflammatory disorders varying in degree of severity and extent. The term "septic abortion" has also taken on a certain ambiguity and is even used to denote any abortion complicated by infection. The terms "septic abortion" and "septic condition" are often used synonymously. Infected abortions with clinical manifestations of septicemia are sometimes classified as "high-fever abortions" or "feverish abortions" with "septic abortion" syndrome. Recommendations for therapy are given: 1.) In uncomplicated infected abortions, the method of treatment is curettage of the uterus in the 1st hours after admission into the hospital. Medicinal preparation conducted for 2-6 hours before curettage reduces by nearly 1/3 the danger of inflammation spreading from the uterine cavity to the myometrium. 2.) When treating patients with complicated infected abortions, expectant-active treatment yields the best results. Curettage of the uterus is safe only after normalizing temperature, alleviating symptoms of toxic poisoning, and reducing local manifestations of infections. 3.) For patients with pronounced toxic poisoning related to resorptive-toxic fever or septicemia, clinical and laboratory observation and treatment must be conducted according to general procedures for acute sepsis therapy. Considering the special diathesis of these patients to septic shock, special measures to prevent shock should include increasing the dosage of antihistamines, medium doses of corticosteroids, and individually selected doses of heparin. This increases resistance to active intervention and the related entry of toxic substrate from the uterus into the blood stream. 4.) Treatment for an abortion complicated by generalized infection (septic abortion) should include radical surgical intervention on the primary septic source. The time and extent of surgical intervention are determined in each specific case individually, depending on the nature of the complication (sepsis, peritonitis, anaerobic infection) and condition of the patient. 5.) If indications develop for removal of the uterus, preference should be given to extirpation over amputation, since the harshest changes are usually localized in the isthmus of the uterus.
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PMID:[Debatable questions in the classification and therapy of the infectious complications of abortion]. 294 72

A prospective, randomized study was conducted in 113 women to evaluate the effect of antibiotic prophylaxis with cefotetan versus no prophylaxis in the prevention of post-partum and post-abortion sepsis. The administration of a single 2 g dose of cefotetan at the time of surgery significantly reduced the number of infectious complications, removal of the placenta or an internal inspection were carried out.
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PMID:[Prevention using cefotetan of post-partum and post-abortion infectious complications in intra-uterine procedures]. 314 25

Of a total of 1037 women of reproductive age who died during the period 1976-85 in the Matlab area that was under demographic surveillance, 387 (37%) were maternal deaths. The mean maternal mortality over the 10-year period was 5.5 per 1000 live births (101 per 100 000 women of reproductive age). Major causes of maternal death, which were assessed using a combination of record review and field interviews, included postpartum haemorrhage (20%), complications of abortion (18%), eclampsia (12%), violence and injuries (9%), concomitant medical causes (9%), postpartum sepsis (7%), and obstructed labour (6.5%). Deaths caused by postpartum haemorrhage were positively associated with both maternal age and parity, whereas those caused by eclampsia and injuries were more common among young and low-parity women. If maternal deaths arising from complications of abortion are disregarded, 20% of all maternal deaths occurred during pregnancy, 44% during labour and the two days following delivery, and 36% during the remaining postpartum period.These findings support the need to develop a service strategy to address the risks of childbearing and childbirth in areas such as rural Bangladesh, where almost all deliveries take place at home. This strategy must be based not only on preventive and educational interventions, including family planning and antenatal care, but also on systematic attendance at home deliveries by trained professional midwives, backed up by an effective chain of referral.
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PMID:Causes of maternal mortality in rural Bangladesh, 1976-85. 326 66

After a general discussion of the factors contributing to maternal mortality and morbidity, a solution to both of these problems is suggested for India: an initiative at the district level to improve support, supervision, training, essential midwifery and obstetric care. The general causes of the 200 or more times higher maternal morality risks in developing countries act throughout the woman's lifetime: powerlessness, illiteracy, malnutrition, deficiency of calcium, vitamin D and iron, heavy physical labor, unchecked fertility, lack of prenatal and obstetric care and illegal abortion. The most common causes of maternal morality and morbidity, eclampsia, obstructed labor, hemorrhage and sepsis, have been prevented in developed countries and in China. We know how to prevent them, by technical support and management at the district level. 4 elements are required: 1) adequate primary health care, food and universal family planning; 2) prenatal care and nutrition with referral if needed; 3) assistance of a trained person at every childbirth; 4) access to obstetric care for those at high risk. Rather than spend money or urban specialized hospital centers, half to 2/3 of all fatal complications of childbirth can be eliminated by local hospitals with the ability to do basic obstetrics such as caesareans and blood transfusions. There is a need for further health systems research in the given locale, but what we need now is an initiative on making pregnancy and childbirth safe for all women.
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PMID:On safe motherhood. 342

Microflora of pathological biosubstrates from 25 patients aged from 18 to 41 years with criminal abortion complications such as sepsis, septic shock, septicemia, and septic pyemia, peritonitis and endometritis of various severity was studied. Obligate anaerobic organisms in association with facultative anaerobes were detected in 84 per cent of the patients. Bacteroids were isolated from operation materials of 36 per cent of the patients. Bacteroids in association with Staphylococcus aureus, peptostreptococci and enterococci were recorded in 16, 8 and 24 per cent of the patients, respectively. Composition of the anaerobic and facultative anaerobic microflora was analyzed in the patients with local and general infections. Antibiotic sensitivity assay of the bacteroids showed that rifampicin, metronidazole, levomycetin (chloramphenicol) and clindamycin were the most active drugs. The use of anaerobic techniques enabled to demonstrate that in patients with purulent septic complications of criminal abortion there prevailed anaerobic-aerobic associations. The results should be considered in treatment of gynecological patients with purulent septic infections.
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PMID:[Anaerobic microflora of patients with suppurative and septic complications after non-hospital abortions]. 343 93

A study was conducted in the Tangail district of Bangladesh from Sept. 1982 to Aug. 1983 to estimate the maternal mortality level there and identify its causes and correlates. 3 questionnaires: 1 for maternal deaths, 1 for deaths other than maternal deaths, and 1 for live births were used to collect data. A rate of 56.6/10,000 live births was found, with abortion related deaths contributing nearly 10 deaths/10,000 live births. The major causes of maternal mortality were found to be obstructed labor and sepsis caused by improperly performed abortion. Those at high risk were mothers below age 20 and above age 30 and those above parity 4. No inverse relationship was found between maternal mortality and socioeconomic status. Community level pregnancy monitoring programs, increased attention on the part of family planning workers toward teenaged, older, and high parity mothers, and nutrition supplement programs for anemic mothers are recommended. This study was faced with a number of methodological limitations that have implications for future research on maternal mortallity in Bangladesh. The number of live births was underestimated, and some types of maternal deaths might not have been detected. These methodological limitations could be corrected by following a 2-step data collection procedure.
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PMID:Maternal mortality in rural Bangladesh: the Tangail District. 348 41


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